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9/12/24, 5.3’3 PM IMG_4352.jpg <br />Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14. Completed by:DateTitle <br />Health Permit <br />PapwHNUfTaMii <br />CuUlrtflBM/d <br />Bteicti <br />Propino Stove <br />Propone Twk <br />RfmoWolwSoep and Water <br />Fbe ExSr«iMMf <br />Ice Cooler <br />J <br />TEMP EVENT APPPeoa 8 of 11 <br />1/1https^/mail.googte.com/maiVuAWseardVnancy rivera382%40gmail.com/FMf cgzQVzXfRvQSncT]qznRCIGvDgifti?proiector-1 <br />SOalHandwoih <br />Wartawetor Contetnar <br />8wmoWC»>»«lno <br />Dish <br />Garbage <br />Can <br />Booth must be on Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SanMEarbucM- <br />biBKhavniarior <br />Uodno w^kig ctoth* <br />5 <br />I 1868 E. Hazelton Avenue | <br />run lAJi? <br />I soopdipaniar <br />^61-; <br />10. <br />••Important" <br />BlMdi and Water I <br />S AN.JO AOUIN <br />J ------COUNTY------ <br />Grnnfncjj grow\ here. <br />I em providing the following cold temperature <br />All food vendor booths are subject to Inspection. Please make a ‘nf <br /> preparation SdZZ!: Ro^rn «°rdlnM°r throe weeks priorto <br />this event. A z NR 9/03/2024 <br />__________ <br />Signature <br />controt tor the cold holding of potentially hazardous foods below <br />45T (If food Is used the following day, maintain below 41‘F temperature). <br /> Ice chests QRefrlgerator <br /> Refrigerated truck bath and tubs Other (specify)—------------------------------------------- ~ <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utens! <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one (or rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths In bleach solution. <br />I am providing (he following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />JggTater supply dispenser with warm water at a minimum of 100T (l.e. 5-20 gallon container with spigot). <br />^<ne separate tub (bucket or basin) for the collection of rlnse/wastewater. <br />J^Paper towels and pump-style soag container. <br />Names of responsible persons Io be present In booth during all hours of operaUon: <br />Nancy rivera ____________ <br />tiondtMMOlfolVMtKuna ■ <br />Stockton, California 95205 | T 209 468-3420 | F 209464-0138 | www.sjgoworg/ehd <br />Eldra <br />Water